WEST DOVER-Vermont Businesses for Social Responsibility held their 20th annual fall conference at Mount Snow Wednesday, November 14, with an opening plenary panel session aimed at answering questions business owners have about changes coming to Vermont’s health care system.

VBSR’s mission as a nonprofit, statewide business trade organization is to advance business ethics that value economic, social, and environmental bottom lines through education, public influence, and workplace quality. This panel was an educational component, preparing business owners for the changes that come with the 2013 and 2014 federal mandates under the Affordable Care Act. As Bram Kleppner, co-chair of the Medicaid and exchange advisory board said, “VBSR has had a long-standing position to always advocate for changes in our health care system. Between Obamacare and Green Mountain Care, we’re moving in some very different directions, and some very positive ones. Now we are at the point where all of us as members, businesses, and organizations need to figure out how to execute and implement the changes that are coming to us.”

Kleppner served as moderator for a panel that included Robin Lunge, Vermont Director of Health Care Reform, Julie Lineberger, a member of the Green Mountain Advisory Board and Medicaid and exchange advisory board, and Kevin Goddard, vice president of external affairs and sales for Blue Cross and Blue Shield of Vermont.

Lunge began the session by explaining the health care exchange that Vermont is required to construct before January 1, 2014. With an exchange, Vermonters and small businesses will be able to shop for insurance on Vermont Health Connect, a website that provides apples-to-apples comparisons of different insurance products. “There are not many fundamental changes to health insurance under the federal law,” said Lunge. “It’s a way for consumers to have easier access to shopping tools.” Lunge also said that as of October 1, 2013, individuals and businesses could begin using Vermont Health Connect.

Insurance plans provided through the exchange will be required to feature essential health benefit packages, co-pays, and deductibles. People who do not purchase insurance beginning in 2014 will be fined with a tax penalty. Lunge said that individuals will still be allowed to purchase insurance through private brokers. However the exchange makes the process easier, and creates a more stable environment for companies to insure their employees. “For those of you who have been in small group insurance where you have small businesses clustered together and you have just a couple of really ill people in a year, it could really increase your rates, so the idea is a bigger pool stabilizes across a larger population.”

Lineberger, who is also a Wilmington business owner, thinks that it is important for business owners to talk to their employees individually, to hear their concerns, and know how the changes to health care will affect them. She also said that de-coupling insurance and employment is a direction health insurance must move toward. With the Affordable Care Act requiring subsidization of insurance premiums for individuals in households with incomes up to 400% of the poverty line, Lineberger says it creates confusion. “It’s important for us to provide insurance to our employees, but what does this mean?” said Lineberger. “It might be more responsible not to offer insurance on two levels. One, because it would be better coverage for our employees, and two, because health care should be de-coupled from employment. You shouldn’t have to be coupled to your employer to get the coverage you need.”

Small businesses, those with 50 employees or fewer, face a tax penalty should they not offer health insurance to their employees through the exchange. The panel spent time exploring the pros and cons of de-coupling insurance and employers. Kleppner asked, if the tax penalty a business is charged is lower than the amount it would cost to insure employees, and employees can purchase insurance through the exchange along with subsidies and tax credits, is it more sensible to not offer insurance? Kleppner says this issue has become more important with the federal definition of a small business going from 50 employees to 100 employees or fewer. Kleppner said that in Vermont, a business with 100 employees or fewer isn’t exactly a small business.

New out-of-pocket maximums, or the total amount an insurance company requires an individual to pay toward the cost of his/her health care, have also put the squeeze on businesses. “If we choose to stop offering insurance, the question we face is if we have been subsidizing employees’ insurance to some extent, do we continue somehow to subsidize their costs so that the individual costs don’t go away, even though the total costs may go down?” said Kleppner. “It’s a business by business decision, but it’s a complicated choice.”

Another feature of Vermont’s health care exchange that will benefit businesses is portability. If an employee purchases health insurance through an employer and leaves one job for another that does not offer insurance, they can keep their same plan as an individual. Lunge said instead of automatic disenrollment due to a change in one’s life circumstances, “Portability will encourage a continuity of care and make sure that people’s health conditions are kept under control and they don’t lose their insurance.”

Lunge says the goal of health care reform must focus on leaving a for-profit system where quality and quantity of care do not equal out. “If you look at the United States as compared to other developed countries, we spend in some instances twice as much as other countries but our outcomes are not as good, so we’re paying more and we’re getting less. What we’re focusing on is how we get to a more sustainable and cost-effective system.”

Lineberger believes one way to ensure quality health care is to focus on individual needs. This includes making payment for services easier by combining multiple procedures in one bill in a system called bundling. “ Bundling puts the onus on care providers to work as a team to create the best outcome for each particular situation,” said Lunge. “A standard procedure for knee replacement may require 20 physical therapy appointments. But some people may need 12 and others may need 30. What this does is let providers create a package for the individual so they’re not wasting money, but providing better after-care because the worst thing for that entity would be if that person needed to be re-hospitalized.”

Kleppner believes the exchange will help businesses and the individual. “We all know people who need their jobs because of the insurance, and that’s just a terrible situation to force someone into. I’m very hopeful this reform will unleash a lot of entrepreneurial energy and creativity because people won’t have to be chained to an employer because of insurance.”